Active NPI
Bloom Davis
- Social Worker
- Portland, OR
National Provider Identifier
1366354920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 4110 NE 122ND Ave Ste 115
Portland, OR 97230-1384 - Phone
- (971) 227-3553
- NPI assigned
- Sep 18, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
4110 NE 122ND Ave Ste 115
Portland, OR 97230-1384
Mailing address
4512 NE Wygant St
Portland, OR 97218-1648
Phone (971) 319-5059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1789689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789689600000",
"number": "1366354920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4512 NE WYGANT ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972181648",
"telephone_number": "971-319-5059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 NE 122ND AVE STE 115",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301384",
"telephone_number": "971-227-3553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "BLOOM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-18",
"last_updated": "2026-09-18",
"certification_date": "2026-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.